Risk factors of parastomal hernia in patients undergoing laparoscope radical cystectomy and ileal conduit diversion

Q4 Medicine 中华泌尿外科杂志 Pub Date : 2019-11-15 DOI:10.3760/CMA.J.ISSN.1000-6702.2019.11.009

Xiong Yifan, Shao Haiyan, W. Shuai, Zheng Wei, Qi Xiaolong, Zhang Da-hong

{"title":"Risk factors of parastomal hernia in patients undergoing laparoscope radical cystectomy and ileal conduit diversion","authors":"Xiong Yifan, Shao Haiyan, W. Shuai, Zheng Wei, Qi Xiaolong, Zhang Da-hong","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.11.009","DOIUrl":null,"url":null,"abstract":"Objective\r\nTo investigate the incidence rate of parastomal hernia(PH) among patients who have received laparoscope radical cystectomy and ileal conduit diversion and to discover the risk factors for PH.\r\n\r\n\r\nMethods\r\nData of 162 patients who underwent surgery of laparoscope radical cystectomy and ileal conduit diversion for bladder cancer between Jan 2012 and Dec 2017 were studied. The patients who had suffered other tumors before surgery or without follow-up data were excluded. At last, 148 patients were enrolled in this retrospective study. According to the occurrence of PH, the patients were divided into two groups: PH group and non-PH group. There were 21 patients (12 males and 9 females) in PH group. The mean age was (66.5±8.6) years old, and mean body mass index (BMI) was (33.4±5.2) kg/m2. 11 patients with synchronous disease and 10 patients without synchronous disease before operation in PH group. Postoperative T stage <T3 in 17 cases, ≥T3 in 4 cases. 4 Cases received neoadjuvant chemotherapy and 5 cases received adjuvant chemotherapy. Tumor recurrence was found in 6 cases. 16 cases had hypoproteinemia. Ileal conduit was made through abdominal incision in 9 cases, and 12 cases was made with laparoscopy. After the surgery, there was severe cough in 7 cases and abdominal distension in 7 cases. 3 cases had previous abdominal operation, and 5 cases had history of glucocorticoid use. The mean size of the stoma was (3.0±0.6) cm. The mean length of the outflow tract was (11.2 ±1.3) cm. We did trans-rectus stoma in 4 cases, and para-rectus stoma in 17 cases. There were 127 patients (82 males and 45 females) in non-PH group. The mean age was (71.4 ±7.4) years, and the mean BMI was (28.8±4.1)kg/m2. 60 patients with synchronous disease and 67 patients without. Postoperative T stage <T3 in 96 cases, ≥T3 in 31 cases. 29 patients received neoadjuvant chemotherapy and 39 cases received adjuvant chemotherapy. Tumor recurrence was found in 38 cases. 66 cases had hypoproteinemia. Ileal conduit was made through abdominal incision in 55 cases, under laparoscopy in 72 cases. There was severe cough in 34 cases and abdominal distension in 38 cases. 21 cases had previous abdominal operation, and 35 cases had history of glucocorticoid use. The mean size of the stoma was (2.3±0.4) cm. The mean length of the outflow tract was (12.2±1.6) cm. 4 cases had trans-rectus stoma, and 17 cases had para-rectus stoma. Postoperative rate of PH was estimated using the Kaplan-Meier methods. Chi-square test were used for the univariate analysis between group of PH and the normal one. Multivariate Logistic regression analysis was used to judge the independent risk factors of PH.\r\n\r\n\r\nResults\r\nPatients were followed up for 24 months. PH occurred in 21 cases, the 1, 2, 5 year cumulative incidence of PH was 9.9%, 5.4% and 16.7% respectively. Clinical characteristics, including age at surgery(χ2=4.018, P=0.045), obesity(χ2=3.949, P=0.047), perioperative hypoproteinemia(χ2=4.279, P=0.039), chronic constipation(χ2=5.416, P=0.020), stoma location(χ2=6.464, P=0.011), stoma size(χ2=3.915, P=0.048), were significantly different between the PH group and the normal group(P<0.05). Multivariate Logistic regression analysis shows that obesity(OR=1.326, 95%CI=1.102-1.548, P=0.043), stoma location(OR=0.892, 95%CI=0.854-0.931, P=0.028), stoma size(OR=1.365, 95%CI=1.089-1.631, P=0.028) were the independent risk factors for PH.\r\n\r\n\r\nConclusion\r\nWe demonstrated that most of PH usually develop in 2 years after undergoing radical cystectomy with ileal conduit diversion. Obesity, stoma location and stoma size are independent risk factors. Preoperative counseling and preventative measures regarding PH formation should be emphasized, particularly in those patients with risk factors.\r\n\r\n\r\nKey words: \r\nUrinary bladder neoplasms; Radical cystectomy; Urinary diversion; Hernia","PeriodicalId":10343,"journal":{"name":"中华泌尿外科杂志","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"中华泌尿外科杂志","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.11.009","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}

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Abstract

Objective To investigate the incidence rate of parastomal hernia(PH) among patients who have received laparoscope radical cystectomy and ileal conduit diversion and to discover the risk factors for PH. Methods Data of 162 patients who underwent surgery of laparoscope radical cystectomy and ileal conduit diversion for bladder cancer between Jan 2012 and Dec 2017 were studied. The patients who had suffered other tumors before surgery or without follow-up data were excluded. At last, 148 patients were enrolled in this retrospective study. According to the occurrence of PH, the patients were divided into two groups: PH group and non-PH group. There were 21 patients (12 males and 9 females) in PH group. The mean age was (66.5±8.6) years old, and mean body mass index (BMI) was (33.4±5.2) kg/m2. 11 patients with synchronous disease and 10 patients without synchronous disease before operation in PH group. Postoperative T stage

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腹腔镜根治性膀胱切除术和回肠导管引流术患者并发造口旁疝的危险因素

目的了解腹腔镜根治性膀胱切除术和回肠导管引流术后造口旁疝（PH）的发病率，探讨PH的危险因素。排除了在手术前或没有随访数据的患者。最后，148名患者被纳入这项回顾性研究。根据PH的发生情况，将患者分为两组：PH组和非PH组。PH组21例，男12例，女9例。平均年龄（66.5±8.6）岁，平均体重指数（BMI）为（33.4±5.2）kg/m2。PH组术前同步病变11例，无同步病变10例。术后T分期＜T3者17例，≥T3者4例。4例接受新辅助化疗，5例接受辅助化疗。肿瘤复发6例。低蛋白血症16例。经腹部切口制作回肠导管9例，腹腔镜下制作回肠导管12例。术后出现严重咳嗽7例，腹胀7例。3例有腹部手术史，5例有糖皮质激素使用史。造瘘口的平均大小为（3.0±0.6）cm，流出道的平均长度为（11.2±1.3）cm。经直肌造瘘4例，副直肌造瘘17例。非PH组127例（男82例，女45例）。平均年龄为（71.4±7.4）岁，平均BMI为（28.8±4.1）kg/m2。同步性疾病60例，无同步性疾病67例。术后T分期

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来源期刊

中华泌尿外科杂志 Medicine-Nephrology

CiteScore

0.10

自引率

0.00%

发文量

14180

期刊介绍： Chinese Journal of Urology (monthly) was founded in 1980. It is a publicly issued academic journal supervised by the China Association for Science and Technology and sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. This journal mainly reports on the latest scientific research results and clinical diagnosis and treatment experience in the professional field of urology at home and abroad, as well as basic theoretical research results closely related to clinical practice. The journal has columns such as treatises, abstracts of treatises, experimental studies, case reports, experience exchanges, reviews, reviews, lectures, etc. Chinese Journal of Urology has been included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences), CSCD Chinese Science Citation Database Source Journal (including extended version), and also included in American Chemical Abstracts (CA). The journal has been rated as a quality journal by the Association for Science and Technology and as an excellent journal by the Chinese Medical Association.